University of Virginia Health System

Obesity in Teens Studied

Two new studies on adolescent obesity are concerned with long-term obesity effects as well as a possible solution for the condition.

Another report, also in the journal, found that the diet medication sibutramine - brand-named Meridia® - along with behavior therapy, helps very obese adolescents lose weight. The study was funded by Abbott Laboratories, Inc., the makers of Meridia.

Teen Obesity and Premature Death Linked

In the first study, researchers found a link between teenage obesity and premature death among 102,400 women enrolled in the Nurses' Health Study II.

The women, who were aged 24 to 44 at the start of the study, were asked to recall their weight when they were 18 years old. During 12 years of follow-up, 710 of the women died.

The researchers, led by Dr. Frank B. Hu, an associate professor of nutrition and epidemiology at the Harvard School of Public Health, found that a higher-than-normal body mass index, or BMI, at age 18 was associated with as much as a three-fold increased risk for death, compared with girls who had a normal BMI.

BMI is a measure of weight proportionate to height, and is considered a useful measurement of the amount of body fat.

Hu says excess weight during adolescence can increase the risk for heart disease and diabetes, both of which can lead to complications and death in adulthood.

"The link between childhood obesity and premature death is an important public health issue," Hu says. "Prevention at early ages is an important strategy to combat this problem."

Medication Plus Behavior Therapy Successful

In the second study, researchers assigned 498 very obese teens, 12 to 16 years old and weighing an average of 215 pounds, to receive either sibutramine plus behavior therapy, or a placebo.

"This is the first study to evaluate whether sibutramine in addition to a lifestyle-modification [behavior modification] program helps very obese adolescents," says lead author Dr. Robert I. Berkowitz, an associate professor of psychiatry and pediatrics at the University of Pennsylvania School of Medicine, and director of the school's Weight and Eating Disorders Program.

Sibutramine works by increasing the feeling of fullness and reducing hunger, Berkowitz says. "We saw there was a significant difference in weight in the two groups after a year," he says.

The second component of the study, behavior modification, works by helping people to change and gain control over unwanted behaviors.

Over a year, those teens taking sibutramine and attending behavior therapy lost an average of 14 pounds, while those taking the placebo gained about four pounds.

In addition, those taking the diet pill and receiving behavior modification therapy also lowered their risk for heart disease by lowering their cholesterol, triglyceride levels, insulin levels, and insulin sensitivity,  Berkowitz says.

These findings could prove valuable in the United States, where 15.5 percent of teens are overweight.

Berkowitz notes that sibutramine is not currently approved by the US Food and Drug Administration (FDA) for children under 16 years of age.

"We need long-term studies to determine the long-term side effects," he says. "There were small increases in blood pressure and pulse rate in the trial, which have to be monitored."

"Treatment with sibutramine [along with behavior therapy] may be helpful under careful monitoring," he adds.

Note of Caution Sounded

One expert, however, does not think pills or surgery are the answer to the obesity epidemic facing today's teens.

Dr. David L. Katz, an associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine, notes that while recent adolescent studies show positive results from gastric bypass surgery and medication therapy, relying on medications or surgery to treat obesity among our youth is indicative of "glaring societal failures."

"Obesity is preventable by means well understood and at our disposal - increasing physical activity, and reducing caloric intake. Unlike drugs and surgery, these options enhance overall health, come at low or no cost, and do not impose a risk of complications," says Katz.

These findings are especially interesting when juxtaposed with those of Hu's study on the impact of adolescent obesity on future mortality, Katz says. "Perhaps the judicious use of weight-control medication could be used to mitigate this threat [to adolescent health]," he notes.

Always consult your child's physician for more information.

Preventing Obesity

Obesity is a chronic disease affecting increasing numbers of children and adolescents as well as adults.

Obesity rates among children in the US have doubled since 1980 and have tripled for adolescents. Fifteen percent of children aged six to 19 are considered overweight compared to over 60 percent of adults who are considered overweight or obese.

Earlier onset of type 2 diabetes, cardiovascular disease, and obesity-related depression in children and adolescents is being seen by healthcare professionals.

The longer a person is obese, the more significant obesity-related risk factors become. Given the chronic diseases and conditions associated with obesity and the fact that obesity is difficult to treat, prevention is extremely important.

A primary reason that prevention of obesity is so vital in children is because the likelihood of childhood obesity persisting into adulthood is thought to increase from about 20 percent at four years of age to 80 percent by adolescence.

Children and adolescents generally become overweight or obese because they do not get enough physical activity in combination with poor eating habits. Genetics and lifestyle also contribute to a child's weight status.

Recommendations for prevention of overweight and obesity during childhood and adolescence include:

• Gradually work to change family eating habits and activity levels rather than focusing on a child's weight.
• Be a role model. Parents who eat healthy foods and participate in physical activity have children who are more likely to do the same.
• Encourage physical activity. Children should have 60 minutes of moderate physical activity most days of the week. More than 60 minutes of activity may promote weight loss and subsequent maintenance.
• Reduce time in front of the television and computer to less than two hours daily.
• Encourage children to eat when hungry and to eat slowly.
• Avoid using food as a reward or punishment.
• Keep the refrigerator stocked with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks and snacks high in sugar and fat.
• Serve at least five servings of fruits and vegetables daily.
• Encourage children to drink water rather than beverages with added sugar, such as soft drinks, sports drinks, and fruit juice drinks.

Always consult your child's physician for more information.